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Form Downloads

For your convenience you may download and complete the forms below to bring in, email or fax to my office.

PHONE:  (360) 336-6809
FAX: (360) 633-3201

Phone & Online Consultation
The information in the above forms is very important in helping me identify the root causes of your imbalances. I will then form a *TCM diagnosis and create a specialized diet and lifestyle program for you. This may entail phone consultations or office visits.

Fee Scale for Phone and Online Consultations:

Phone Consultation (per 15 minutes)$25.00
In-Depth 1 hour Phone Consultation$75.00
Health Questionnaire Form Evaluation$25.00
Symptom Survey Form Evaluation$25.00

Payments Accepted through PayPal

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